Search Results (23)

Centella asiatica (CICA)-derived exosomes have emerged as bioactive agents for skin rejuvenation due to their regenerative and anti-inflammatory properties. This study evaluated the safety and efficacy of a topical ampoule containing CICA-derived extracellular vesicles (EVs) in healthy Korean adults. This human application study was conducted over a 15-day period, during which the test formulation was topically applied to the skin following a controlled regimen. A 24-h patch test with 30 participants confirmed non-irritation (irritation index: 0.00). In a separate two-week trial (n = 20; mean age 50.7 years), 3D imaging and ultrasound assessed five-dimensional pore improvement (area, density, volume, filling, texture), wrinkle depth reduction in five facial regions, dermal hydration at 0.5, 1.5, and 2.5 mm depths, and skin density. Significant reductions were observed in mean pore area (−17.9%) and pore density (−26.9%), with a 9.0% decrease in surface roughness. Wrinkle depths decreased by 7.8–18.8% across the forehead, glabella, crow’s feet, nasolabial folds, and neck. Hydration increased by 7.9% at 0.5 mm, and dermal density improved by 12.7% (p < 0.05). These findings highlight the excellent skin compatibility and multifaceted cosmetic benefits of the formulation containing CICA-derived exosomes and other active ingredients, underscoring its potential as a safe, effective, and innovative anti-aging cosmetic agent. Full article

MBA-P01 is a newly developed botulinum toxin A (BoNT-A) product designed to provide similar clinical effects as OnabotulinumtoxinA (ONA-BoNT-A), thereby providing an alternative treatment option for glabellar lines. It is another holotoxin preparation containing BoNT-A1. This randomized, double-blind, active-controlled, multi-center, Phase III clinical trial aimed to evaluate the efficacy and safety of MBA-P01 compared with OnabotulinumtoxinA (ONA-BoNT-A). In total, 318 participants were enrolled and received 20 units of MBA-P01 or ONA-BoNT-A on the forehead and glabella. At the 4-week assessment, the primary endpoint revealed no significant difference in the improvement rate of glabellar wrinkles between the two groups, confirming the non-inferiority of MBA-P01 to ONA-BoNT-A. Furthermore, some evaluation variables showed higher improvement rates for MBA-P01 than for ONA-BoNT-A. Adverse reactions and other safety analysis results were considered acceptable. Interestingly, a subgroup analysis of patients with the coronavirus disease (COVID-19) showed that the duration of BoNT-A treatment was shorter among those who contracted COVID-19 after BoNT-A treatment compared with those who have not. The limitations of this study include the predominance of female participants and the exclusive enrollment of Korean patients. MBA-P01 is expected to be clinically useful in terms of the efficient and safe reduction of glabellar wrinkles, which will provide patients with additional treatment options. Full article

Background/Objectives: Fluoroscopy has been widely adopted in interventional pulmonology, as it facilitates real-time visualization of the bronchoscope, endobronchial ultrasound, and biopsy tools during procedures. The purpose of this study was to evaluate the effectiveness of radiation shields in minimizing scattered X-ray dose to the bronchoscopist in a phantom study and to determine the dose of scattered X-ray dose to medical staff with radiation shields in clinical application. Methods: An anthropomorphic torso phantom was positioned on the fluoroscopic table between the C-arm X-ray tube and the image detector to mimic bronchoscopic operations. Upper and lower body lead shields were used to examine the effectiveness of radiation shielding. Scatter radiation rates were assessed at a first operator location using real-time dosimeters with and without protective devices. In clinical application, the scattered X-ray dose of the first operator and main assistant was measured using wearable radiation dosimeters during 20 procedures. Results: In the phantom study, scattered radiation without shielding was 266.34 ± 8.86 μSv/h (glabella), 483.90 ± 8.01 μSv/h (upper thorax), 143.97 ± 8.20 μSv/h (hypogastrium), and 7.22 ± 0.28 μSv/h (ankle). The combination of upper and lower body lead shields reduced the scattered X-ray dose by 98.7%, 98.3%, 66.2%, and 79.9% at these levels, respectively. In clinical application, mean scattered X-ray dose rates were 0.14 ± 0.05 μSv/procedure (eye), 0.46 ± 0.51 μSv/procedure (chest), 0.67 ± 0.50 μSv/procedure (hypogastrium), and 1.57 ± 2.84 μSv/procedure (assistant’s wrist). Conclusions: The combination of radiation shields significantly reduced the scattered X-ray dose at the operator site in the phantom study. The scattered X-ray dose to medical staff during bronchoscopy can be kept at a low level with the aid of a shielding system. Full article

Dacnusini is a species-rich tribe in the subfamily Alysiinae, with most species exclusively serving as parasitoids of leaf-mining Diptera (Agromyzidae). The number of genera discovered in China remains limited, which is apparently insufficient considering the global diversity of species and genera within this tribe, particularly given the vast and ecologically diverse landscapes of China. In the present study, three new record genera, Victorovita Tobias, Coloneura Foerster, and Laotris Nixon, were documented for the first time in China. In addition, the species delimitation approach and haplotype network analyses based on the COI sequences, combined with morphological evidence, were employed to delimit species. The findings indicated three new species: Laotris glabella sp. nov., Laotris aethidentata sp. nov., and Victorovita aequalis sp. nov. Additionally, K2P divergences showed no overlap between intra- and interspecific genetic distances in the Laotris and Victorovita species. Detailed descriptions for new species and keys to the species of Laotris and Victorovita are provided in this paper, along with the documentation of two new species records for China: Victorovita caudata (Szépligeti, 1901) and Coloneura stylata Foerster, 1863. Full article

Introduction: The DRAF III procedure is indicated for the treatment of benign and selected malignant frontal sinus pathology. Several attempts have been made to find an intra or pre-operative measurement that was predictive of the feasibility of this operation and its success. Among those, the frontal sinus outflow tract anteroposterior diameter (FOAP) appears to be the one with the highest applicability in clinical practice, since it is easy to measure on pre-operative CT scan. The objective of the study is to evaluate whether the minimum and maximum frontal sinus outflow anteroposterior diameters (FOAP min and FOAP max) are associated with the risk of failure and consequently with the need for surgical revision. Secondly, we ought to evaluate whether the angle between the glabella and the nasion on the sagittal plane could influence surgical outcome. Material and Methods: This is a retrospective study on patients who underwent DRAF III for benign pathologies at a tertiary Italian referral center from January 2000 to July 2022. FOAP min and FOAP max were measured on the mid-sagittal sections of a pre-operative CT scan. The glabella–nasion angle (G-N angle) was calculated on the same sagittal section. These measurements were compared between patients who experienced a recurrence and those who did not. If a post-operative CT scan was available, the obtained anteroposterior diameter (OD) of the frontal sinus neo-ostium was also measured on the same section. A correlation analysis was performed between the three pre-operative radiologic parameters and OD. Results: Twenty-nine patients were included in the study. Six patients experienced restenosis requiring surgical revision. The median FOAP max resulted significantly higher in patients who did not experience recurrence (median: 14.8 mm, IQR: 3.84) than in patients who experienced a recurrence (median: 11.9 mm, IQR: 1.14) (p = 0.04). The FOAP max also showed a good positive correlation with OD (p = 0.0001; r = 0.7). The correlation between FOAP min and OD was not statistically significant, nor was a correlation found between FOAP min and recurrence risk. The G-N angle was not significantly different in patients who experienced recurrence and those who did not, nor did it show a correlation with OD. Discussion: The FOAP max might be a valid pre-operative radiologic parameter to guide a surgeon’s approach to a DRAF III procedure, as it is easy to measure, shows a good correlation with OD, and seems to influence the risk of recurrence. Full article

Background: For optimal clinical outcomes in full mouth rehabilitations, it is vital to determine the optimal jaw relations and confirm the appropriate vertical dimension of occlusion (VDO). The current study aims to evaluate various facial measurements as an adjunct in determining VDO in dentate individuals. Methods: A total of one hundred and twenty subjects, sixty males and sixty females, of the age group 19-30 were selected for the study. VDO (chin–nose distance) and other facial measurements like the glabella to subnasion (G-S) distance, both right and left pupil to rima oris (P-R) distance, both right and left corner of mouth to outer canthus of eye (M-E) distance, and both right and left ear to eye (E-e) distance were measured using a Vernier caliper. Results: The mean ± standard deviation of the C-N distance, G-S distance, right P-R distance, right M-E distance, left M-E distance, right E-e distance, and left E-e distance were 67.70 mm ± 3.22 mm, 60.29 mm ± 3.67 mm, 65.99 mm ± 3.72 mm, 66.00 mm ± 3.91 mm, 69.51 mm ± 3.71 mm, 69.48 mm ± 3.68 mm, 69.59 mm ± 3.98 mm, and 69.51 mm ± 3.95 mm, respectively. Pearson’s correlation coefficient between the C-N distance and M-E distance was found to be 0.739 (right), 0.730 (left); that between the C-N distance and E-e distance was found to be 0.738 (right), 0.732 (left); that between the C-N distance and P-R distance was found to be 0.660(right), 0.670(left); and that between the C-N distance and G-s distance was found to be 0.417. Conclusions: The present study reported a high positive correlation between the chin to nose distance and the distance between both the right and left lateral corner of the mouth to the outer canthus of the eye, and the distance between both the right and left ear to the eye. Hence, these measurements can be used as an adjunct for establishing VDO in the edentulous patient. Full article

Objectives: The aim of this study was to evaluate through analysis using CBCT the transverse and axial diameters of the mandibular condyles in subjects affected by juvenile idiopathic arthritis (JIA) and compare them with those of healthy subjects. Methods: The study was conducted on CBCT scans from the digital archive of the Department of Biomedical Surgical and Dental Sciences, University of Milan, including patients with JIA and using healthy subjects as controls. Inclusion criteria: aged between 7 and 25 years old at the time of the CBCT examination; Caucasian ethnicity; diagnosis of JIA according to the International League of Associations for Rheumatology (ILAR) criteria documented in patients’ records; TMJ involvement; good quality CBCTs covering our region of interest (ROI), from the glabella to the mandibular inferior border; no previous orthodontic/orthopedic treatment; no history of craniofacial trauma or congenital birth defects involving the craniofacial area. Each CBCT scan underwent examination using 3Diagnosys^® software. Since data were normally distributed, parametric tests were used for analysis. The sample was divided into three groups: (1) bilateral JIA subjects, (2) unilateral JIA subjects, and (3) healthy controls. Results: We found a statistically significant reduction (p < 0.0001) in the transverse diameter (TR-Diam) of the affected condyles by an average of 1.7 mm, while the axial diameter (AX-Diam) again showed a slight reduction, on average by 0.1 mm, with a non-statistically significant value. Another comparison was made between the unaffected condyles of patients with unilateral JIA and the healthy condyles of the control group. The unilateral unaffected condyles were found to be slightly smaller than those of healthy patients, but without statistically significant differences. We found that in both JIA males and females, the condylar growth tends to stop earlier than the healthy ones. Conclusions: The transverse diameter was found to be more affected than the axial one, causing typical bone resorption and condylar shape. Moreover, we showed that the pathology, in the case of unilateral JIA, does not compromise only the affected condyles; the corresponding condyle that seems to be healthy is actually partially compromised. In addition, we observed that the growth of affected condyles of JIA subjects tends to stop earlier than the condyles of the healthy controls. Full article

Filler injections in the upper face pose significant challenges due to its complex anatomy and proximity to vascular structures. High-frequency Doppler ultrasound offers real-time visualization of facial anatomy, improving both safety and aesthetic outcomes. This paper presents a detailed overview of the ultrasonographic anatomy of the temples, forehead, and glabella, along with reproducible, ultrasound-guided filler injection techniques for these areas. We use two scanning techniques previously described: “scan before injecting” and “scan while injecting”, applicable to subdermal, interfascial, and supraperiosteal planes in the temporal region, as well as the glabella, forehead, and supraorbital region. Ultrasound guidance for filler injections in the upper face can enhance procedural efficacy and safety. By integrating real-time imaging, practitioners can navigate the intricate vascular anatomy more effectively, thereby minimizing the risk of complications. This study highlights the need for ongoing research and continuous education to further refine these techniques and improve patient outcomes. Full article

Background: The growing popularity of aesthetic procedures on the face raises the question of their safety. The forehead region is crucial aesthetically, but due to its abundant vascularization, it is also one of the most dangerous areas for dermatologic procedures, especially in the glabella area. The purpose of this article is to review the literature on the arterial vascularization of the forehead to identify potential high-risk zones for aesthetic dermatology procedures. Methods: A database search (PubMed, Web of Science, Scopus, and Embase) was conducted, and the titles and abstracts of all identified studies were screened, followed by full-text evaluation. Results: We identified 714 articles during the database search, and 25 articles were included in the review. The included studies used cadaveric dissection and computed tomography applied to cadavers as well as Doppler ultrasonography on volunteers to evaluate the forehead arteries (supratrochlear (STrA), supraorbital (SOA), central (CA), paracentral artery (PCA), and frontal branch of superficial temporal artery(FBSTA)). A total of 1714 cases involving the forehead arteries were analyzed. The included arteries were observed over a relatively large area, and their locations varied. The CA and PCA in cadaver studies were observed in an area of 0.2 to 10.8 mm and 0.8 to 16.2 mm, respectively, on the entire path from the glabellar point to the frontal prominence point. The distances from the midline in cadaveric studies at various measurement points ranged from 0.6 to 28.0 mm for the superficial branch of the STrA and 13.6 to 40.7 mm for the deep branch of STrA. In case of SOA, the distance from the midline ranged from 23 to 32 mm. Measurements from the midline in Doppler studies ranged from 0 to 23 mm for STrA and from 10 to 50 mm for the SOA. In studies using computed tomography, STrA was observed at a distance of 11 to 21 mm and the SOA at a distance of 21 to 32 mm, both lateral to the midline. Conclusions: Medical professionals should be aware of zones where frontal arteries are more likely to be encountered. The glabella region appears to be one of the most dangerous areas for dermatologic procedures. It is believed that the supratrochlear, supraorbital, and the paracentral arteries may cause ophthalmic complications due to occlusion of the ophthalmic artery, while this risk for the frontal branch of the superficial temporal artery seems to be low but cannot be completely excluded. Full article

The forehead and temporal region are frequent areas of skin cancer development. After tumor removal, reconstruction must be performed, maintaining the frontal–temporal line of the scalp and symmetry of the eyebrows in an attempt to hide the scars within these marks or natural folds and wrinkles. Second wound healing and skin grafts generally do not produce an acceptable cosmetic result. When direct closure is not possible, the technique of choice is skin flaps. In the midfrontal line continuation of the glabella, there is a remnant of skin to be used as a donor area for local flaps; similarly, it occurs in the preauricular cheek, which can move toward the temple. In addition to the classic advancement and rotation flaps, the frontalis myocutaneous transposition flap is an excellent technique for closing defects which are wider than higher on the forehead. Its design is very versatile and can be performed between the two pupil lines at different heights depending on the location of the defect. On the other hand, the preauricular skin advancement flap with an infralobular Burow’s triangle is also an excellent option for reconstructing tumors in the temporal area. Full article

Background: The injection of dermal fillers for facial esthetics has become a very popular procedure. Although usually safe in the hands of the experienced user, filler injections may bear a risk of unwanted side effects. Material and Methods: This is a narrative review of dermal filler migration after facial injections. We performed research on the literature on Pubmed and Google Scholar. Inclusion criteria were observational studies, case reports, and clinical trials which investigated the association of facial filler injections to filler migration. Animal studies have not been considered. Intravascular injections were excluded. Results: We identified 28 reports that met the inclusion criteria. The age range of affected patients was 21 to 86 years (mean ± standard deviation: 47 ± 14.8 years). Women were 25 times more reported than males. Hyaluronic acid and polyalkylimide were the most commonly encountered filler substances. Injections into the nose, lips, nasolabial folds, and forehead (including glabella) are more often reported for filler migration than injections into the cheeks. Tear-trough correction bears a risk for orbital migration. The delay from injection to presentation of filler migration was highly variable. Very late filler migration was more commonly seen with permanent fillers than non-permanent products. Conclusions: Filler migration distant from the injection site can occur even several years after the primary treatment. All filler types can be involved. Permanent fillers bear a higher risk of very late filler migration. Migration of permanent fillers needs surgical treatment, while HA fillers respond to hyaluronidase injections. Detailed knowledge of facial anatomy, safer injection techniques, and filler qualities are preventive measures. Full article

Facial skin aging is the most visible manifestation of aging in the body. In this study, we aimed to rejuvenate aging skin via a one-time intradermal injection of autologous adipose-derived stem cells (ADSCs). Eight patients were enrolled for study. Photographs of patients taken immediately before and 1, 3, 6, and 12 months after ADSC injections were comparatively evaluated for visible skin manifestations. ADSCs were cultured from the abdominal-skin-derived subcutaneous fat tissue, and 1 × 108 cultured ADSCs were injected intradermally into the facial skin. Cultured myoblasts were incubated with the supernatant derived from ADSCs, and the effect was evaluated via glucose consumption and lactic acid production in the medium. Eight cases showed the shallowing and disappearance of wrinkles, including those of the glabella, lower eyelids, crow`s feet, and forehead and nasolabial grooves, a month to several months after treatment. Double eyelids became prominent, and facial pores significantly reduced in size. These effects lasted for over one year. Myoblasts cultured in the presence of an ADSC-derived exosome were activated compared to that of ADSCs cultured without supernatant. The result supports the role of muscle in ADSC skin rejuvenation. The present study first reports that a single intradermal administration of cultured ADSCs rejuvenates aged facial skin over the course of one year. Further, patients exhibited definite double eyelids and pore shrinkage, strongly indicating the active involvement of muscle, which was supported by an in vitro study. Our study also suggested the important role of biological factors delivered from injected stem cells, although the detailed mechanism of rejuvenation effects of ADSC skin injection remains to be clarified. Full article

This study compared manual and digital measurements of plagiocephaly and brachycephaly in infants and evaluated whether three-dimensional (3D) digital photography measurements can be used as a superior alternative in everyday clinical practice. A total of 111 infants (103 with plagiocephalus and 8 with brachycephalus) were included in this study. Head circumference, length and width, bilateral diagonal head length, and bilateral distance from the glabella to the tragus were assessed by manual assessment (tape measure and anthropometric head calipers) and 3D photographs. Subsequently, the cranial index (CI) and cranial vault asymmetry index (CVAI) were calculated. Measured cranial parameters and CVAI were significantly more precise using 3D digital photography. Manually acquired cranial vault symmetry parameters were at least 5 mm lower than digital measurements. Differences in CI between the two measuring methods did not reach significance, whereas the calculated CVAI showed a 0.74-fold decrease using 3D digital photography and was highly significant (p < 0.001). Using the manual method, CVAI calculations overestimated asymmetry, and cranial vault symmetry parameters were measured too low, contributing to a misrepresentation of the actual anatomical situation. Considering consequential errors in therapy choices, we suggest implementing 3D photography as the primary tool for diagnosing deformational plagiocephaly and positional head deformations. Full article

Study Design: Retrospective analysis at a tertiary care center. Objective: This study describes a method of analyzing postoperative results using lateral view clinical photographs to create normalized projection ratios of the glabella and radix. Methods: We reviewed preoperative and postoperative photographs of 15 patients. All photographs were in the lateral view Frankfort horizontal plane. We calculated the distances between the (a) tragus and cornea, (b) cornea and radix, (c) cornea and glabella, and the (θ) nasofrontal angle. Results: Fifteen sets of patient photographs were analyzed and found that there was a favorable 14% reduction at the radix and an even greater reduction (78.9%) at the glabella. The nasofrontal angle was improved to a more feminine range from 131.84° preoperatively to 145.86° postoperatively. Conclusions: Normalized projection ratios of the glabella and radix, along with the nasofrontal angle, can be used to objectively measure outcomes of frontal feminizing cranioplasty. Full article

Botulinum toxin (BoNT) is an anaerobic rod-shaped-neurotoxin produced by Clostridium botulinum, that has both therapeutic and lethal applications. BoNT injection is the most popular cosmetic procedure worldwide with various applications. Patients with dynamic wrinkles in areas such as the glabella, forehead, peri-orbital lines, nasal rhytides, and perioral rhytides are indicated. Excessive contraction of muscles or hyperactivity of specific muscles such as bulky masseters, cobble stone chins, gummy smiles, asymmetric smiles, and depressed mouth corners can achieve esthetic results by targeting the precise muscles. Patients with hypertrophic submandibular glands and parotid glands can also benefit esthetically. There are several FDA-approved BoNTs (obabotuli-numtoxinA, abobotulinumtoxinA, incobotulinumtoxinA, letibotulinumtoxinA, prabotulinumtox-inA, daxibotulinumtoxinA, rimbotulinumtoxinB) and novel BoNTs on the market. This paper is a narrative review of the consensus statements of expert practitioners and various literature on the injection points and techniques, highlighting both the Asian and Caucasian population separately. This paper can serve as a practical illustrative guide and reference for optimal, safe injection areas and effective doses for application of BoNT in the face and oral and maxillofacial area. The history of BoNT indications, contraindications, and complications, and the merits of ultrasonography (US)-assisted injections are also discussed. Full article